Very, very warm. Welcome to everybody back in the room. And, um, on teams we have a.
Um, great amount of attendees here. Also, actually even more online.
So will one come to all of you? Uh, my name's Ashley, and I'm an academic GP at the Department of Primary Care in Oxford.
Um, every year, together with my colleague Helen Marie, who find the room, um, we we have the very pleasure of organising, um,
the module on global health in translational health fine fit,
which is part of the machine translation Health Sciences, led by um, Professor Trish Pinho.
And, um, sorry, who's also here, but the back. And this session is, um, our guest lecture, which is part of our MSP module.
And we have immense pleasure to be able to open it to the university and the public today.
So, um, at the right here, I've got, um, a couple of, uh, few lines, a few rows full of, um, MSC students.
Um, throughout this week we've had, um, the pleasure of together been able to explore, um, many topics related to global health.
We've spoken about what cyber health actually means.
It's historical roots, um, what decolonisation looks like in, um, global health and how to approach a given global health problem.
We have looked at the importance of context, particularly geopolitical context, historical context, socio economic context.
We've looked at the various players in the global health field, um, ranging from local actors to national and multilateral global organisations.
And one thing we've certainly come to realise together is the importance of how history has shaped current global power dynamics and realities,
and how acknowledging these complex history and backgrounds is critical for understanding the current realities in the world and shaping,
hopefully, our hope for the future.
Today, I have the real pleasure and honour of having our guest lecture on the topic of healthcare in humanitarian crisis,
where we'll be focusing on Gaza, and this is an extremely important topic to cover, um, very dear to many people's hearts.
And that painful topic too.
We've seen the humanitarian disaster for the past six months in its acute phase, but very importantly, for the years and decades preceding this.
Two, as many of you will know, healthcare workers, doctors, nurses,
paramedics all have been playing a very crucial role in humanitarian crisis situations around the world.
And we have seen the same happen in Gaza.
Not only are they, not only have they been working under horrendous conditions to provide emergency care with huge constraints, um,
placed by a destroyed healthcare system, um, but they have also very sadly been targets of war themselves,
with hundreds of them being killed in the past months. Another crucial role played by healthcare workers, um,
have been to bear witness to the experiences of people living in Gaza and to share these experiences with the wider world.
This has provided glimpses into what is happening on the ground to hundreds of thousands of people, most of whom have been women and children.
Um, these people who have don't have themselves access to the international audience that I've colleagues here have.
Therefore, um, this leads me on to say that today we have the absolute honour of having the call itself Doctor Brenda Kelly,
Doctor Jane Foley and doctor,
I'm excited with us who all have experience the work in Gaza as medical professionals over the past decade or so, some longer.
What I've done is to ask them, um, specifically to also reflect on, uh, what it means to frame what's going on as a humanity,
um, humanitarian crisis and the implications of how, um, the situation is,
um, perceived, um, by the world and what it means for the people, especially, um,
reflecting on what that is may lead to possible dehumanisation of the people suffering on the ground.
Let me introduce you to our speaker today, Mr. Douglas, the consultant surgeon and associate professor at University College London.
He chairs the board of the medical education charity of his Foundation for Medical Schools in Palestine.
And he's been to class a number of times since December 2023.
And his last trip, he returned from it only last week, so his memories are very fresh,
and we're very lucky that [INAUDIBLE] be able to share some some of his very recent experiences on the ground.
Then we'll have Brenda Kelly, who is a consultant obstetrician at the German Radcliffe Hospital, who'll be speaking about women's health in Gaza,
uh, followed by Doctor Jane Pauley, who's a paediatrician who's worked in global child health for many years.
Um, who will speak about how children have been affected by the war.
Um, and finally, Doctor Sharma said will be joining us for the training, as well as a GP and a tutor,
Simmons College, um, and a clinical associate professor at the University of Leicester.
He also works with colleagues towards the development of primary care in Palestine.
So we have an amazing bunch of speakers, um, and not enough time to actually, you know, make it all justice.
Um, but I'll hand over to, um, doctor the West now, um, I hope you find the session really thought provoking.
We'll have between 45 minutes. Um, tick to 55 minutes of lecturing, followed by the half an hour Q&A.
Um, and we're looking forward to also taking questions from the online audience, as well as all of you here in person.
Thank you so much for this. Do you find this?
If you can do this. I just come off?
Yeah. So you got a good point. What we've done.
Yeah, I think we're on. Good afternoon.
It's a real pleasure to be here. Gaza.
When I left to go from Cairo to Rafah a few weeks ago, I met somebody.
I met a lady in a town called a parish, which is about 40km on the northern coast of Sinai,
and she was a Palestinian who left Gaza just the previous day.
And when I asked her. Sheepishly how things were.
I mean, I knew how things were. She said to me, she said the phrase in Arabic.
Yeah. Was Colby the pain in my heart. And I think anybody who goes to Gaza will appreciate how painful it is to watch
the unfolding agony and misery that is affecting everyone that lives there.
I'm going to tell you stories of people who were there.
I think my function as a clinician was not purely to go and help on the clinical side and work in hospitals, but also to tell the stories.
I speak Arabic. I was able to ask them questions about how they sustained their injuries, what's happened to their lives,
what happened to their homes, and those are the stories that I find most painful.
Gaza is part of what used to be British Mandate Palestine, and before that it was part of the Ottoman Empire for 400 years.
And it was divided then by the colonial powers in the early part of the 20th century between France and,
and Britain and Palestine and Transjordan were administered by Britain.
It then developed into a partition plan, and this was as a result of huge immigration, mainly from from Europe,
from Europe, uh, of of Jews who were escaping Europe and mainly after the Second World War or escaping the Holocaust.
1949 after a war broke out, because Israel, uh, self declared a state in 1948, there was a war that was fought.
The Arabs lost the war. And the map you see in the 1949 armistice area is is the map, as it was back in between 1948 and 1967.
1967 came along. Israel won another war very dramatically in the six days and captured West Bank, Gaza, Sinai and the Golan Heights.
Things have changed since then, in the sense that Egypt then established a peace treaty with Israel,
and the Sinai Peninsula was returned to Egypt and go to remain underneath under Israeli control.
Um, though they have been declared, uh, unilateral Israel as being part of Israel, as has Jerusalem been.
And this is this is a progressive change in the map of Palestine.
Uh, as it was before 1948. Until what it is now.
So the the green areas, uh, the areas which were inhabited by Palestinians, Arabs, um, of all religions at the time.
Uh, mainly Muslims, but also about 10%, uh, Christians and a small population of passing and Jews.
Um, and then the 1947 partition plan is obvious.
Uh, 1967 is the reality of what's happened, 1948.
And nowadays, if you go to the West Bank, particularly the West Bank is not a contiguous area of, uh, Palestinian control.
It's a it's a it's a series of settlements or towns in Palestine surrounded by Israeli settlements, which are mainly on the hilltops.
And and I've been there several times and,
and the settlements become more and more prolific and more and more numerous, uh, and surrounding the towns.
So they are there's no area you can now call literally a continuous passing control there in the West Bank.
It remains under Israeli military control.
And Gaza, after 2005, when the Israelis unilaterally pulled out to the settlements and they they they redeployed the army to surround the Gaza Strip.
And it meant that the land borders were completely closed, as is the sea.
The sea limit, uh, for fishermen varies between 3 and 6 miles, uh, on average.
Before 1948, Gaza was historically.
Gaza is a 4500 year old city.
It's been through, uh, the the all the all the major changes that you expect of a land which sits at the junction between Africa, Asia and Europe.
And I thought you could see it in the population.
You will find, uh, unusually and curiously, a population of ginger, very pale looking people in Gaza.
You'll find blondes, you'll find African looking people, and you will find the typical Middle Eastern look as well.
So it's quite interesting that that, that that small area contains such a variety of people.
Now that that is a result of the migration that happened in 1948 as well,
when a lot of Palestinians moved from along the coast, from from from from Jaffa.
Uh, yes. Down the coast towards the Gaza Strip. And some moved from the desert.
So from the from the Negev, from, uh, there Sabah zero seven Beersheba to the area which is now known as Gaza.
So that that's changed and that's what became part of what became the population of Gaza is what we see nowadays.
Gaza was also and its area around Gaza is one of the most fertile parts of that territory and remains so until recently,
the hills of the the West Bank where Hebron is, plus the springs in the Negev desert used to feed the river which runs through Gaza.
It's called Wadi has dealt with the valley of Gaza,
and that is now the line and demarcation line between where the Israeli army has stationed itself and built a road between you,
Military Road and the southern bit, which is where they are, which is the central bits of Gaza and further south towns like San Yunis and Rafah.
So what it has there was a river. Now it's not there's a river, there's a bridge over it, and it's used as a military landmark.
And the camps that you might have heard about to say that the zoo is the way they are all around that area of Gaza.
And after 1948 and between then in 1967, the population initially lived in tents, as we see nowadays.
So this is being repeated again and then re-established, uh, some sense of civic normality.
It was run administered by the Egyptian government in that period of time.
And then when the Egyptians lost control, it became fully underneath the control of the Egyptian military and remained so until 2005.
So when they redeployed their forces. This is a picture that is actually at the Rafah crossing as you cross some Egypt into Gaza.
This is a picture of Gaza in 1936. And that minaret is the famous minaret of the Al Omar in Moscow, the Great Mosque of Gaza.
This was initially a um, a temple, uh, pre Christianity, then became a church, then it became a mosque.
The mosque was destroyed and then it became a church again during the crusaders, uh,
period in Gaza and then again destroyed several times by earthquakes and wars and finally destroyed again a couple of months ago by,
uh, bombing by the Israeli forces. And this is that we have to Gaza nowadays.
So a population of 2.2 million, uh,
completely surrounded and and I'll show you a video at the end of what the fence and the wall looks like around Gaza.
I took it, uh, step. Seriously.
I wasn't meant to, but I thought, this is worthwhile watching this, and I'm not really sure I understood why we couldn't film it.
Uh, because it's being, you know, you can see it on any any TV channel or any news channel.
The the fence and the wall is a combination of concrete and some wire fences.
And there are two main exit or entry points into Gaza, one which is in the north place called Erez, which I think in Hebrew means nation.
Um, and the South Rafah or Kerem Shalom in Arabic of Wasallam.
So, so this is, this is 2017. This was what walking into Gaza looked like.
This was you cross what looks like an airport building and you come out.
The picture on the left is as you go walking in towards Israel, and there's a sign saying welcome you to Israel.
And, uh, this is a walkway. This is a walkway that I've taken several times when I came in and out of Gaza and behind those walls,
which is where the welcome sign is used to find. Hundreds of Palestinians trying to get into Israel for two reasons.
One is for Labour. So cheap labour, uh, lots of, um, building and construction Labour would go across every day with special permits.
And then the other line, which was very crowded and very tense,
were for patients who are trying to either go to Israel or go to the West Bank in Jerusalem for treatment.
And the reason they were there was a lot of tension was because they they had appointments and they had taxis to get to the other side,
and they often missed those on the right.
Then is the walkway you'd have to take is about a kilometre and a half from that point on the left towards the Palestinian passport check.
And, and you can walk this and I walked it and some people can get these kind of tick tock, um, a go cart.
I think it called TikToks and over there as well and interesting enough, um, and the it's very dramatic, as you can see,
but also as you look to your sides, you can see the wall, uh, the separation wall between Gaza and Israel.
And this is these are the exams that I went as an examiner to help with.
I was the external examiner to the, uh, European Hospital in Gaza.
You will if you are following the news, you will hear about the European Hospital,
which is one of the two main functioning hospitals which actually are hospitals rather than small clinics left in Gaza.
So this hospital was the the place where we sat, the exams, you, the medical students in the final year?
Uh, this was seven years ago. So I expect some of them, uh, well into their medical careers.
Now, this hospital is now a pure trauma centre, and it's absolutely stacked with patients and their relatives.
And it looks very, very different on my last trip, uh, in 2019, in fact, 2023,
I was there last summer at the end of the exams, the dean of the medical school, who was back in the photograph.
Who's that man with the suit?
Uh, he offered to give us a tour of Gaza, and I obviously took that offer up, and he asked the driver to take us on to suspension.
So he said, go in through to the cemetery, take him to this particular palace.
I mean, the palace in inverted commas. This is somebody's old home.
And the first thing they did was take us to the British cemetery, the only patch of green grass that you can see in Gaza.
It looks very nice. And the people were they use it as a park, as a public park.
So the people having picnics around the edges. And I said to the driver, this is not what I want to see.
I want to see what Gaza really like. So he took me to the right side, which is his camp where he lives.
This isn't, say, camp in the middle of Gaza, the centre of a lot of very, uh, very, very, um, violence,
fighting and bombing and shooting at the moment and places where we saw lots of patients coming from.
So this is where he lived, set up camp, and you can see the houses and you can see that when a house is targeted.
It's not just the house, it's targeted. So these are the figures.
We've heard a lot of these figures. The and this is up till a couple of days ago from Australia.
Uh, this is the United Nations Office for the Coordination of Humanitarian Affairs.
Uh, a mouthful. Um, so they produce these things on a daily basis.
And 34,000 plus killed so far.
Um, the number of casualties as a civilian injured patients is about 77,000 at the moment.
Now, I'll show you why these figures don't necessary told the full story in a second.
But this is again the casualties in totality so far.
And you can see that seems to be a levelling of the curve. And you wonder why. Uh, I think the levelling of the curve is now,
because a lot of the big towers that were hit very early on without any warning have have been destroyed.
The main towers in Gaza. Remember, the population of Gaza City, uh, represents more than half the population of the Gaza Strip.
But look at this figure here, which is from The Economist back in November.
And the reason I put this up is if you count up the dead, the killed in the top, uh, the top row, they add up to about, um, 14,000.
The missing add up to about 7000. So we are talking about potentially a 50% inaccuracy rate in the number of kills so far.
And then this acronym, which came up, uh, during the Gaza War, wounded child without with no surviving family.
Very common. I saw it myself, uh, in both injured children, but also in, uh, children who come up to us in hospital asking for help.
And you'd asked in the story. And I mean, one particularly sticks in my mind because I felt guilty.
So having to say I have nothing on you and I didn't have anything on me to give him,
but also the idea of giving some giving money in a place like that, for example, is problematic.
You can imagine that would what would that that would produce in terms of, uh, your own safety and how much attention you bring to yourself?
But he came up to me, uh, I think a 5 or 6 year old and, and asked me for money and I, and I asked him why.
Why he's asking for money. Told me that his whole family's killed, and he was living with a family, which is, uh, which were were neighbours of his.
Now, my instinct at the time is I live in London. So am I in sync with somebody else's money is to say, what are you really using it for?
And I had to remind myself that I'm not in London anymore, and that actually I'm listening to someone's story, which is real.
And he. And though he was not putting on emotions, that itself did not change the facts.
And I had to remind myself that I in a different in a very utopian environment.
When then when the war happened, map the medical aid for Palestinians, put out a call for volunteers to go out to Gaza and help out.
And I know in Gaza and knowing where, how I feel about the population of Gaza, I volunteered and went out with a group of people.
Some of them are Oxford surgeons and doctors, and some of them are from around the world nowadays.
And when we first went in, we were given this map. This map is just demonstrates how the Gaza Strip has been completely divided into blocks.
And the blocks are given numbers.
And depending on what number blocks you're in, uh, you then read into it the degree of safety or not that you are putting yourself through.
So we were staying uh, at the in 89, which is you can see chalet on the left.
That's block 89. And that was a safe block because it was green. Green meant that there were no ground forces in that area.
Red meant there were ground forces in the area. So it's really a relative term of safety.
There is nowhere that is safe in Gaza where we would say didn't actually officially in December,
January we heard explosions, particularly overnight, which were very, very close.
Of course, when we asked our Palestinian colleagues by then, they said, oh, they're far away.
They're a kilometre and a half, two kilometres away, uh, a kilometre and a half.
When you got a £500 or £1000 bomb does not see like a kilometre away, you know,
the house shakes, the windows shake the rattle, and it feels very like. And then we worked in the hospital in zone 128.
That is the Al-Aqsa hospital there. And you can see that, uh, just north of that where the circle is.
That was where a lot of fighting was happening. That distance is probably around a kilometre, a kilometre and a half.
That was the focus of a lot of fighting. No, stay right is just to the left of it.
Uh, in those sort of six, six, two, six, six one.
Uh, and that was again three months later when I went back a few weeks ago, was still ongoing.
There was still ongoing shelling and, and, and death and people coming from the hospital from that the zone on a daily basis.
And this these are the trucks that were coming in through Rafah. So this is on the other side of the border in Egypt.
There were kilometre upon kilometre of these trucks lined up, some of them waiting for weeks to get in.
And the demand, we know the demand. This one is for about 500 trucks per day.
That was pre-war. So you add a war situation to that, then your requirements should probably double and it should be 1000 trucks a day going in.
We now know through these figures that actually the maximum number on average per day is maybe about 200.
And you ask yourself, why is it? And, you know, I mean, the complexity here is you can you could we could talk about aid for as long as we want,
but as long as the killing is happening, aid is just a plaster. So aid may be something.
Just to say your own is maybe as a as a nation, as a government.
But it's certainly doesn't solve the problem. What do you want going into Rafa?
This is what you see. And this is ongoing. These pictures are from December, but the same pictures I saw this time around again.
And you drive along the donkey carts because they are at the premium now.
They don't need fuel and they need less feeding.
And you can put a cost the back of it and carry six people on and make a living out of transporting people if you have to.
But also you can put all your life, belongings and your children on there as well to transport transport them.
On the left is a baba. There are lots of babas in Gaza.
We've had a baba sitting outside the hospital, in the emergency department, in the Al-Aqsa hospital.
And uh, particularly because I was there during Ramadan and the beginning of Aids and during a year,
just supposed to buy new clothes and have a haircut and look good. So he was pretty busy, and he was only about 15 years old.
And then this is what a targeted, targeted setting looks like.
I don't know what particular that was used here, but, uh, this house was utterly destroyed.
And you can see it's not just one house. It's a whole block that's been destroyed.
And bear in mind, our movement was very restricted in Gaza.
So we all movement is restricted by the Israeli army and forces.
They tell us where we can and we can't go. We were seeing these on a regular basis.
And of course, the one of these houses was hit when we were there.
So we drove in the next morning in December to the hospital, and the house was destroyed like this.
And you wonder who was in there. The crowd.
The crowds at the hospitals are everywhere. These.
This is a this. On the left is the reception area, which is just where the staircase starts in the main block of the Al-Aqsa hospital.
And on the right you can see the the crowds. It often takes you a few minutes just to line up to get to the next, next level.
We'll come down the staircase and these crowds are still the same.
I get asked, how is it different between then and now? And the difference is that the hospital grounds are less busy.
People have moved south, but the hospitals themselves are very, very busy.
And you still have 700 700 people in hospital. That's only has 140 bed capacity plus 30 maternity beds.
These are not patients. The 30 maternity beds are for ladies having babies.
These are not patients per se. So now it's full. It's full of former patients.
And, uh, the, uh, the pervasive thing is wound infections, wound infections affecting everybody and everything, the stench of pus.
And I do not exaggerate when I say this is nauseating.
Uh, every wound has pus pouring out of it. It is like walking into a hospital, perhaps in in this country in the 18th century.
And one of the wards, which used to be a, which was meant to be an extension to the operating theatres.
This says in Arabic, but some say Crossrail, an awful department with with wonderful people in it.
And this is a thing. I mean, people recognise the facilities, the what's, what's available because the resource is absolutely awful,
but there are some wonderful people in it and that includes the staff and also the patients and their families.
The families are the caregivers.
It's not the health care workers because there's just too many patients for anybody, for any member of staff to be able to look after them decently.
And this picture again is from January. And some of you will recognise the back of Professor Maynard.
Um, and I went with him and these doctors with us, uh,
doctors who graduated 1 or 2 years ago and now doing stuff which I wouldn't have done when I was a graduate.
At the two stage, I've been I'm doing this now after 15 years of working as a consultant,
and these people are doing it after two years because they've had to take on the responsibility.
A lot of the older doctors have either moved south with their families.
Some have been killed, uh, and some of them just on a daily basis, can't show up because they've got their own families to worry about.
They've got to move them. And if they're living in tents, make it even more difficult.
And many of them are living in tents. And the operating itself was mainly about shrapnel.
It was shrapnel, shrapnel and shrapnel. And it still is. Shrapnel was trapped and shrapnel with occasional bullets as well.
So this is what it looks like. It's a piece of either could be wood, could be concrete, could be a bit of metal.
And it's searing hot because when the explosion happens, it heats up so much it pierces the body.
It causes an unknown damage when you look at it from the outside, and you can see the size compared to the blade there,
and it causes damage in terms of intestines, it causes bleeding.
It causes injury to the lung, to the heart. You can't tell what's going to happen if you are within a few hundred metres of an explosion like this.
What's happened is unpredictable and many of these injuries are life changing.
So we're talking about amputations as well as abdominal a lot of people with stoma bags.
So these are bits of intestine. And now we have to divert the intestines because they've been ruptured to empty onto the skin.
Put bags on them. You you might have heard of colostomy and all of these these need reversal.
We're talking about hundreds of thousands of people who will have this.
When were they going to have it done? I mean, that's that in itself is work that will take years to do.
And this is a bullet that I took out of somebodies bladder only two weeks ago.
Uh, so this bullet had gone through the left chest, through the left abdomen, uh,
and done some damage to the intestines and and piercing of the bladder, the bladder, the bladder.
And, uh, we unusually don't we don't know. We find these.
So I took a picture of this. You can see it's it's unique in its shape. On the right are the pictures of the corpses that were dug out of hand.
You this only ten days ago. Two weeks ago. So this is.
I met the man, and he's a 19 year old man who we used to be used to work in his chicken farm with his father.
His name is, I would say, is a very tall man, very tall and skinny.
And when he met me came the smiling people. I was a photographer, a cameraman, and, uh.
And I said, why don't you come and see what we what we do?
So I walked into the mortuary, and these are ten bodies that were retrieved out of the rubble of communists.
You can see some of them, maybe not so clearly, are bodies of children.
Uh, and they don't know who they are. So they're labelled as unknown module.
They are kept for three days, and if nobody claims them, then they buried.
But the stench you get at the corpse that's been lying, dissolving for days, decomposing.
It's pretty awful. And one of the one of these corpses was taken out of an ambulance when I was there.
And. And they gave me a mask on. I had a mask anyway. But something you need to put something on because it's going to be unbearable.
And so the ones who are, uh, identifying are buried the same day.
Uh, I had permission to show this picture. This is Ennis, and this is, um, uh, Ennis is 19, went to retrieve some some items from his property, uh,
in the north of, uh, Dell, but, uh, and as soon as he arrived, he was hit directly, uh, with a shell is exposed nearby.
He ended up with a bit of a second. Goes a lot to his chest. He ended up with a ruptured at the altar.
Um, and I put this picture slightly proudly and slightly showing off because he did pretty well.
This is three days later, and he gave me permission to take pictures,
and also took a video of him, which I have taken, and I and I got his consent for it as well.
You can see on the left what's what, apart from that little tiny hole with his chest,
with the bits that's coming from his veins in his neck all distended.
This is what's called cardiac component. Uh, Rafa again.
We went to Rafa to see the crowds in Rafa, and then you could see somebody sitting in the, um, in the shaft of a lift.
That was his bedroom. Um, these are the zones you find in the hospital.
The blacks and the reds. The blacks. Those are full where the corpses are piled up and the red zones are for the taller patients.
And these are in every hospital. In this instance, those black them was empty because it was in the afternoon.
And they buried the bodies in the morning. Uh, briefly touch on what happens to women and children.
And this was a sign that you find nearly on every pharmacy door in Gaza.
And this says ladies at bumpers. Bumpers.
Because in Arabic is a P, so they say bumpers instead of Pampers. Uh, and that to me is a nappy.
There were no nappies and there were no female hygiene products. Uh, this was back in general.
Things are a little bit better now, but this is, you imagine adding this to a shelter which has 30,000 people.
Roughly a third of them are women with one toilet per 600 people.
And it gives you a picture. Uh, one of the difficult days, I had to remember.
This is three, three children lying two on the floor and one on the bed there.
Um, and the boy on the bed. We had to take the boy in the middle who was on the ventilator off the bed, putting on the floor because he was dying.
He had a head injury and he was not going to survive that. And the boy on the table, uh, had a big hole in his chest from shrapnel.
And that's his sister on the floor. The boy on the bed probably died because we didn't discover his energy till after we put him on the bed.
His sister had a broken leg that had to be straightened out without any other static.
And then you saw in these kind of explosions, uh, in the distance of Gaza.
This is from the house where were staying at the time. And these explosions were at a depot where the gas, domestic gas is being stored.
So every aspect of life really was targeted. We left Al-Aqsa hospital back in January because the hospital was targeted with this,
but that went through the wall, uh, probably came from a tank and hit the ICU window.
This is the hospital that we were staying in. It was hit a week after we left it there.
The second mission was in the hospital. It was hit. Lucky nobody got killed.
But this was investigated by the UN and it was an F-16 fired missile that hit the house.
You can see there's nothing around it, so a mistake is unlikely.
This is the NSF House. That was about a kilometre away from us.
And you can see the tide window in the in the middle there. Two people died when the house was hit in mid-February.
I'll show you a brief video. And I know the time is tight. I'm sorry.
The man I met, but he is a 19 year old who started working wrapping bodies months ago.
He used to run a farm family with younger chickens, and he described to me how he ran the bodies of seven people killed last week by the Israeli army.
And he was done at midnight, and then the next morning by the Red cross to wrap up, to be buried in their home country.
You can hear the noise. That's the drones. That noise is constant.
The only time it stopped was when Iran retaliated with those missiles and the drones.
That morning was quiet for a few hours. I woke up into the night thinking, this is very eerie.
And then, of course, it resumed again. This is a photographer.
Uh, you can see his press jacket. He was hit in the sky, right?
The day before we left. And he lost a limb on his, uh, the name on the right leg.
And everything gets everything gets dismantled because everything's being used.
Trees. Um, concrete. Um, anything that's used to build tents is being used in that kind of way.
And then I just want to touch on the issue of the destruction of the educational side of there.
So I work with the medical education side. The number of.
And it's not just about doctors and medics and health care workers.
It's about every thing. Everybody who works in the education sector professors, educators, teachers, pupils,
the number of people killed during this war is is beyond anything that I would have imagined.
And this is the Islamic University of Gaza. And I've been there.
I was there last summer. I mean, these pictures are not pictures of collateral damage.
And this was the last university left in Gaza that was destroyed by mining.
And it was filmed. It was filmed by the Israeli forces as they blew up the mines.
This is the Israel Hospital in Gaza. Some lights, some some some light aspects to my visit in Gaza.
This is the first visit I had.
And this is uh, and this is, um, a Syrian city is a is a five year old girl who was the daughter who is the daughter of a mad colleague.
And she entertained this for the two weeks we were there.
And on this picture on the right is someone she's a medical student in the final year, and I met someone later on.
She's not volunteering in a hospital.
She came to tell me in January that she she wanted to ask me how I was going to help ensure that she finished her education.
And I do worry that women, particularly students, will be will suffer more after this because the focus on trying to find locations for them to train
is going to discriminate against those who are not going to travel away from their families.
Uh, I won't go into all of this, but this is a sign saying, you know, patients who've given themselves jobs to do.
And these are families. So one man says, hold on. He's a nursery man.
He was standing outside our room. He stepped outside our room just a few weeks ago.
One of them is, um, that looks to be a physiotherapist.
He provides, uh, massage, sugar for every tea.
It's always sugar with a bit of tea. There was a video of. I think I have time, so I won't show it or should I?
Sure it's okay. Uh, so this is again, uh, just to give you a flavour.
This is our last day today. This morning, we did a walk around.
Uh, it feels very festive because the little girl we operated on two days ago who
has rendered bleeding injuries died overnight just from something terrible.
And, uh, we continued.
Last night was very quiet for a bit, because I seem to have some preoccupation with what's happening with Iran,
but it's been very loud this morning, had some really loud sound bombs, which shook the building, and we had about 3 or 4 of those and been quiet.
And since then we can hear the gunfire in the distance, machine gunfire, or you might pick it up in the background.
So we are thankful for the sight of helicopter gunfire.
There's a level of anxiety which is higher today and yesterday, uh, mixed emotions about leaving.
Uh, we said our goodbyes, and, uh, if you have some.
There's a final bit here, which I just to show you what the buoy looks like.
And I've just. This is just crossing. This is you can see the concrete there as you cross.
These trucks are coming. And this is the entrance having come from, uh, Kerem Shalom, having been inspected by the Israeli side.
And you can see the distance, the jeeps, these are Egyptian army jeeps, uh,
manning the borders along that fence, uh, and coming out, um, so we don't go into Egypt as we cross.
You can see now that's the fence. Now we are in Egypt and that's it.
And then driving, then on who is got, um, who's there for health reasons, who's there for other reasons.
And all the pay, all the people on there were people who paid $10,000 to leave.
So I a company called hello, which oddly means welcome, but you are welcome for $10,000.
And then the last ten minutes, the last ten minutes of our trip in Gaza were stopping at the beach for a change,
because we left hospital for the first time for some fresh air.
And this was a teen who I went with a wonderful bunch of people who, uh, actually were very good company become friends for life, I'm sure.
Thank you very much. I am fascinated to hear, and I'm sure you have lots of thoughts going through people's minds and emotions.
Um, so the interest of I'm just going to hand over to Brenda.
Thank you. It's, um, an incredibly hard act to follow.
Thank you very much. Um, it's a pleasure to be here.
And thank the opportunity to speak today. Um, this opening slide really is just to say that I'm one of a number of, uh,
ones, a group of incredible people, but particularly, um, to acknowledge, um,
others in the women's health who come as part of the Oxford Medical Teaching Group, um, including Debbie Harrington,
who you've seen in some pictures that colleagues showed, and Bettina, who lived in Gaza for many years.
Um, but nice work in the UK.
Um, and I also want to acknowledge the input of the obstetricians and midwives who are also part of this, um, presentation.
Um, so just by way of context, myself, Jen and Jack, I've been I've got this, um,
quite a few times now as part of the Oxford Medical Teaching Group, um, headed up by Nick Minard.
Um, some of these issues and teaching work that we've done.
Um, and I put this slide in in particular, partly to just tell you that the bonds that are formed, um, with our teams in Gaza are incredibly strong.
Um, it is the most profound and amazing and great privilege of my life to have been part of the teaching groups going to Gaza.
Um, the other reason why I put this slide on, um, is to show you what the Islamic University of Gaza used to look like.
It's one of the two universities that we taught at. Um, and it is devastating to see the, uh, damage that's been done.
Um, um, the deaths I'm telling. I'm just going to get the hang of this slide show.
Just bear with me as I can. Yeah, it's the arrow.
I should have kept my glasses on that one time, you know.
Thank you. Okay. October 8th, we came together as a group in Oxford to say, you know, this is horrendous.
We were due to have been going into Gaza three weeks after that.
Um, and the question on all our lips is, what can we do?
What can we do? And when we were still in communication with our friends and colleagues in Gaza, they knew what would happen in the fog of war.
They knew that their voices be silent. They knew that the electricity would be cut.
They knew the internet would be ropey. And they asked us one simple thing, which was to keep talking, keep sharing their testimonies with the world,
keep bearing witness, and that I hope we continue to do to their, um, to undo the injustice to their words and also put in,
um, a sites, um, message hub, which is really that sort of call for every single one of us in this room,
every single one of you in the, um, online, um, particularly if you're magical.
To bear in mind that we do have a duty.
Uh, medical neutrality has been breached time and time again in Gaza, and that was a breach of humanitarian law.
And it's up to us to speak out where and how we can.
Um, this slide was actually is from the Mosop is a, uh, wonderful poet, Palestinian from Gaza.
And he wrote about his experience of growing up in Gaza. This quote is from a poem from before the war,
and I think it speaks to the expectations that one has growing up in Gaza of perhaps
not making it to old age without risk of death starts even before you're born.
Again, giving birth should not be a matter of life and death.
It should never be. But it is the most vulnerable point in a person's life, both to the mother.
Have been born, and sadly, within Gaza, the chances have come to harm.
As a mother or a child. The newborn child was already, um, very high before the current conflict.
Um, you notice that you can see, um, that the dates in these various, um, news articles, um,
speaking to the decimation of the um, Guardian health care system predate October 23rd.
This is not something that started in October. Some has been going on year on year.
Um, since the occupation. Kelly, it's already mentioned some of the demographics.
Um, I just want to highlight on this slide that Gaza has a very high fertility rate.
Not only that, but there are a significant number of mothers who are under the age of 18 and within the health care system in Gaza.
The returned units have held and were held into areas one with al Qaeda, um and the other enough Noster hospital.
Both hospitals have been used repeatedly in the last few months.
Those hospitals catered for around 34,000 births per year.
They were the largest hospitals, and with the commencement of this current conflict, those women had to be looked after, give birth elsewhere.
But even prior to October 7th, to be a woman pregnant in Gaza was to have a risky time.
Anaemia is rife, but one and two women are anaemic. The risk of um, infection, preterm birth, miscarriage,
stillbirths were already higher and the death rate in pregnancy is about four times that of the national average in the UK.
The neonatal mortality morbidity rate and the stillbirth is also much, much higher somewhere in the region of 10 to 15 times higher.
The remaining maternity care in Gaza is health, and the NGO hospitals are the unwra um to cities,
and there's some private facilities and some of that is provided for in the primary health care centres as well.
It's the same for the next few slides. And what could you talk about in terms of how things are now?
It's important to recognise just the four key elements of maternity care.
I'm just conscious that some of you have had children. So you're aware of the health care system for women who are pregnant.
The first is prenatal care, and the important part of that includes what's really recognised in treating anaemia and the iron supplementation.
Really a lot of that was coming through the NGO organisations.
And in those tracks, the unsullied mentioned necessary survival in Gaza even before October 7th.
But the expectation would be that you would have at least four actionable visits with
a doctor or a midwife to tell them you check the well-being of you and your baby.
We know that skilled birth attendants at delivery is crucial for the survival of both mother and baby, and ideally,
that first taking place and facility with access to emergency supplies such as oxygen, gloves, intravenous access and fluids, and so forth.
About 95% of women in Gaza will give birth in a health facility that was pre-war.
We also know that having access to emergency obstetric community care is vital for those unexpected emergencies that do happen,
inevitably for some women and children, um, around the time of birth.
And again, this is important for the protection of women sometimes and harm from haemorrhage,
from sepsis, um, from preeclampsia and obstructed labour.
And also it's important that if you are a woman who's caesarian section, um, or you the complication of labouring when you have a certain infection,
it's important you have access to safe theatre facilities and anaesthesiologists as well.
And the final part, the first part is postnatal care to establish breastfeeding to check for any complications of birth,
acute infection and haemorrhage, um, to treat anaemia and also for care of the newborn.
All that changed overnight on October 7th.
You'll be already familiar with the lack of field impact that it has in hospitals here,
which is the fact that most of the major hospitals turned overnight from being
units that serve the needs of the population to being major trauma centres.
And in Gaza, in any given year, there are around 50,000 women pregnant.
Now, just to put that in perspective, the population of Gaza is the same as the population of Oxfordshire and Berkshire.
Um, combined, the two countries combined, we might say 13,000 deliveries per year.
So this is a very high birth rate, which means that about 180 woman per day in Gaza will give birth overnight.
That's just a little too much to give birth. Um. Were lost.
Yes, there were some NGOs, some unrest activities, and there was some private hospitals who were given to give up any practice.
They have to take on the turn to services, but were struck not just with lack of places to give birth safely,
but also with the bombing and the bombardment, the inability to access even those hospitals, um, safely.
The decision from many women came down to stay at home and give birth without a birth attendant,
or make the arduous and dangerous journey to hospital where there may not even be a space for staff to look after you in a hospital.
And as the war has progressed, what we've increasingly seen is that women, particularly if we think about that tent encampment around Rafah,
are giving birth in very unsanitary conditions, in tents, between tents, in houses that they're fortunate, as it were, to live in a high sort of flat.
They're not living there in a three bedroom flat of splendour.
They're in this and quite often incredibly overcast, part of conditions, with ten, 15 families in those three bedrooms.
But that access to clean water, to bathroom facilities, to privacy, to dignity.
And that creates huge, um, uh, challenges not just for the woman, but that newborn baby as well.
This the, um, graph on the on your left, um, really sticks to the, uh,
infographic and really sticks to the information, which I'm quite certain many of you are familiar with.
In contrast to previous conflicts in Gaza where the main deaths were amongst combatants, usually younger men, in this war it has changed completely,
as evidenced by the bottom, um, panel there in this war, in this conflict,
70% of those killed putting women and children, about two mothers are killed every hour.
Now, the challenge we have been on the right side of this conflict is when we hear numbers to remember that each of those numbers represents a person.
It represents someone's every.
And the death of a mother will automatically increase the risk for the death of every one of her children, particularly at the age of five.
And the death of the mother is one of the most destabilising aspects of a child's adverse experience in childhood.
It is to lose the anchor points and the person who will care for them.
I'm going to play just this short video. This is from, um, Alvarado Hospital in Rafa.
Again, just by way of context. Al-Shifa and Nasser Hospital between them had about 141st per day.
El Moratti had between 6 and 7.
That's amazing. At most 15 births per day at most.
In a very short space of time, they've had tonight. Cope with the births.
The woman who birthing and able to get to hospital. I'm going to try and play this video to show a good chance we'll get something with this.
If we get something like this in the comments. This will be good if you know what I mean.
Just have been handled with money. And I never had to do the horrific two sentences.
I didn't have them in their desk. The shovel, dead tissue, I get them, I'd.
Sure like to get them some serious sort of lips to put on this that have this sort of yellow [INAUDIBLE] where I have the trailer into the ignition.
And then I said, of course.
Yeah, well, the interface is. Hello, I forgive someone.
We can't be sure that it was a little baby who hit the, we don't know, a little ginger.
Yeah, she lives with that because she television as the amendment to have a disabled child as there was in baby no more.
You can baby what it is that the farmer who created it will be able to assume Shasta and has
lived in the [INAUDIBLE] just window because I should have something will that's awesome in this.
So another I just window to victims of CB missiles for.
Sure get them through with the biggest meal we like.
This is a cigarette. Them.
It's very hard. Again just eat and imagine what it's like as we get them first.
But also remembering that if you do suffer complication in gas at the moment, if you suffer,
for example, haemorrhage, which simply isn't going to be enough blood to to to treat that.
And quite often the obstetricians there said they're having to resort to hysterectomy as a life saving measure for this woman.
And some when times when they're having to do caesarian sections,
it's not that they're often doing them without anaesthetic at all, but sometimes much of it under light sedation only.
So these are very difficult, difficult times for women. I'm just conscious, conscious of time.
So I'm going to show just a couple more slides. We've mentioned contact with some of the obstetricians in Gaza.
Very sadly, we have lost, um, many uh, friends, colleagues in Gaza who've worked in hospitals this, um, with this particular obstetrician.
And again, it's notable that we don't use names because we recognise the safety issues for those people.
Um, it's exposing names and we are sharing those narratives and testimonies of brutality outside of Gaza.
Um, what? I have a good time to go through these.
And particularly but with this particular text message, you can see that with every single line, there's a growing desperation.
You know, that the situation is getting worse and getting worse.
The doctors are exhausted, the literature exhausted. If they can make it to work, they're working round the clock.
If they can't make it to work, they're going to connect to their families under extreme duress.
Um, I'm going to just finish with a very brief line that the numbers that I showed, the numbers that we know about, the 70% of,
uh, of deaths that those being killed being woman and children, please bear in mind that those are the deaths due to trauma.
Please bear in mind that those do not account for those who are unaccounted
for under rubble or have been admitted to hospital with traumatic injuries,
who will die as a result of those traumatic injuries from infections.
So for those numbers are not always being collected, the numbers that are often not being collected robustly.
Of the numbers of pregnant women and newborns dying. What we have here, this report that's come out and corporations, Harvard University.
But just to sort of give you a sense,
this is this isn't the ten months along the bottom far left is maternal deaths near this testing and stillbirth site?
What they have done is model where we think projection of where we think projected death rates will be.
And you can see that with the continued escalation, we will reach an unprecedented number of women and children dying, um, in Gaza.
Um, this is not been seen before in any major conflict.
But please also notice the green line.
So even if there were a cease fire tomorrow, the death rate will continue to rise over and above what it would have been,
which is already high in a pretty complex situation.
And that rise and death rate is partly that the infrastructure is so destroyed there is not enough health care,
even for the most basic, uh, of, um, preservation of life.
So we anticipate, as there has been in the previous conflicts in Gaza, a rise in the death rates.
I'm just going to finish this quote from a wonderful colleague who's working in order to upholster Halston.
I covered the hospital in call. When they call me in at night with more pins above our heads.
This is, of course, a great terror. My wife and children are afraid that the life of the patients in these circumstances is equal to my life.
I go and save the life of a woman. I feel happy.
And time and time again, I think I speak on behalf of my friends and colleagues who've been to Gaza, that the one thing that, um,
is deeply humbling is to see the incredible grace of our colleagues there and the incredible courage that they continue to work under.
And I hope that I've done just that.
This is some of the voices of the workers in Gaza, because they've remained a very to a very special place in all of our hearts.
Thank you very much. Thank you so much, Brendan.
That was very, very touching. Um, I'm just going to hand over to Doctor Jane Foley.
Well. Hello, everyone. Um. I'm going to tell you the story of Fatima.
Fatima, three years old, and she lives in a shelter run by the United Nations relief work agency Unwra in Rafah, at the southern end of Gaza.
Her parents and her two older brothers were killed when their apartment in Gaza City was bombed and destroyed by the Israeli occupying forces.
Fatima was trapped under the rubble for six hours.
She was rushed to hospital where her left arm was amputated.
She was finally discharged into the care of neighbourhood friends, but intense bombardment forced her new family to move south.
First to communists and then to Russia. The animal shelter is densely overcrowded.
People are tense and there are intermittent outbreaks of violence.
This limited access to food and clean water and the two hour wait to use the toilet.
In the past fortnight, Phasma has had two episodes of diarrhoea and she's now got a chest infection.
She asks constantly for her mother. She has nightmares and she sleeps very poorly.
She's hungry, thirsty and very frightened.
She is at WC and S.
A wounded child. No surviving family.
Which is a chilling acronym used by aid workers in Gaza to describe the desperate plight of injured children who've lost their entire families.
The period between conception and three years of age. The first thousand days of life is critical to a child's health and development,
and to their subsequent health, emotional and social well-being, and productivity as an adult.
It's the time of rapid brain development.
And this massive increase in brain complexity in connectivity in response to the child's interactions with the environment.
This early adaptive learning also modifies the way in which genes are expressed.
So creating a blueprint for future health and behaviour during adult life.
Therefore, by impacting on future generations.
In order to develop optimally and attain their full potential.
A child needs nurturing care to be kept safe, healthy and well nourished.
To receive responsive caregiving and to be encouraged to explore and learn from their environment.
Conversely, we also know that a relentlessly adverse intolerant has a negative impact on a
child's emotional and cognitive development and that this has lifelong consequences.
Like most children in Gaza, Fatima is deprived of all five components of nurturing care.
The implications for her and for the future of the Palestinian nation are devastating.
More than 14,000 children have been killed in Gaza since the start of the hostilities,
with women and children accounting for nearly 70% of the 34,000 deaths to date.
Most deaths among children have been caused by bombing and military activity.
That equates to overcrowding, limited access to clean water, widespread damage to sanitation systems,
and reduced access to immunisation means that an increasing number of deaths and now due to infectious diseases, particularly diarrhoea and pneumonia.
Children and adults with chronic diseases such as diabetes and cancer.
And now dying as the continuing blockade of medical supplies and fuel for hospital
generators by the occupying forces is impeding effective medical treatment.
Fatima is one of 74,000 Palestinians who've been injured since the start of the hostilities and have injuries, a life changing.
Malnutrition complicates nearly half of all childhood deaths worldwide.
In children under five. The occupying forces continue to block the entry of sufficient volumes of food and water into Gaza, and this.
Coupled. With the systemic systematic bombing the factories and agricultural production means that
95% of the population of Gaza is now experiencing emergency levels of food insecurity.
Children, pregnant and breastfeeding women.
And mothers with disabilities and and people with disabilities are at greatest risk of malnutrition.
Well infants fed with formula milk run the additional risk of diarrhoeal disease as access to clean water is limited.
And not only is the insufficient food, but the foods that are available are high in carbohydrates but low in protein,
fat, and essential micronutrients, and therefore totally inadequate for children who are growing rapidly.
Of the 32 people who have died tragically from malnutrition and dehydration since the start of hostilities.
28 have been children. In recent nutritional surveys,
10% of children less than two in Raffa and a third of children in northern Gaza have been found to be acutely malnourished,
i.e. severe wasting, as you can see in this child here, compared to less than 1% before the current crisis.
The longer this lasts, the worse the outcome.
Has this good evidence to suggest the children who survive episodes of malnutrition or famine
during childhood fail to grow adequately and to obtain their full developmental potential.
In addition, they run a greater risk of developing cardiovascular disease or diabetes in adulthood.
Responsive caregiving helps the young child to learn not just about their immediate environment,
but also about people, social and emotional relationships, and language.
Fatima is one of 17,000 orphans children in Gaza who have been orphaned or separated from their parents during this crisis,
and is now cared for by unrelated adults who are themselves experiencing extreme stress.
Like 1.7 million others that 75% of the population of Gaza, they they've been displaced from their home and they're experiencing continuing violence,
economic insecurity, lack of privacy, poor sanitation and potential starvation.
In such circumstances, it's almost impossible to provide nurturing care to a young child.
Nowhere is safe in Gaza. 80% of nurseries and educational facilities have been destroyed or damaged.
And the people are too scared to move around.
Fatma is experiencing extreme trauma and violence, and there's no place she can go to explore, play and learn.
This is a war against children. By relentlessly inflicting violence, destruction and starvation on the people of Gaza.
Benjamin Netanyahu is depriving a generation of Palestinians of their childhood.
And leaving scars that will ensure that Israel will never be storms in the future.